TOPICS IN GERIATRICS: SHORT PHYSICAL PERFORMANCE BATTERY (SPPB) The SPPB is a set of objective measures of lower extremity physical performance consisting of standing balance, chair stands, and gait speed. The assessment showing a gradient of risk for mortality, nursing home admission, disability and can be used as an indicator of frailty. The SPPB takes only a few minutes to complete, requires little training, simple equipment, results can be quantified by scores, and it is reproducible and sensitive to functional changes over time.
LEARNING OBJECTIVES: 1) Learn more about the SPPB 2) Learn how to score the SPPB 3) Learn who is appropriate for the SPPB 4) Learn the SPPB outcome measures
SPPB TESTING PROCEDURES1 The SPPB includes three objective tests of lower body function: 5 timed, repetitive chair stands a hierarchy standing balance test, and a timed 8-foot walk. According to specific cut-points a score of 1-4 represents the hierarchical performance for each test.1
Chair Stands: This tests the participant’s ability to rise form a regular height, straight-back chair. The participant will try and stand up five times repeatedly as quickly as possible with arms folded across the chest. The tester allows for a demonstration to establish proper body mechanics and assess performance before testing.
o0 = unable; 1 = > 16.7 sec
o2 = 16.6-13.7 sec
o3 = 13.6-11.2 sec
o4 = < 11.1 sec
Standing Balance: The participant is first asked to place their feet in side-by-side position, followed by a semi-tandem position, and tandem position. In order to advance from the first position to the next, the previous stance must be held for 10 seconds.
o0 = side by side 0-9 sec or unable
o1= side by side 10 sec, < 10 sec semi-tandem
o2= semi-tandem 10 sec, tandem 0-2 sec
o3= semi-tandem 10 sec, tandem 3-9 sec
o4= tandem 10 sec
8-foot walk: The participant is asked to walk at their normal pace from a standing position a distance of 8 feet (2.4 meters) and is allowed to use an assistive device if normally needed. Timing begins one the word “go” from the tester and ends once the established distance is crossed.
o0 = could not do
o1 = >5.7 sec (<1.40 ft/sec)
o2 = 4.1-6.5 sec (1.44- 1.97 ft/sec)
o3 = 3.2-4.0 sec (2.00-2.50 ft/sec)
o4 = <3.1 (>2.56 ft/sec)
By summing the 3 individual test items, a summary score is created. There is a potential range of 0-12, with higher scores indicating better lower body function.
TESTING POPULATIONS SPPB was very predictive of risk of disability among the community-dwelling patients 2. In addition, use of the test has predicted patient mortality, the need for admission to a nursing home and reliance on health care among the general older population, as well as continued decline in ADLs. Most importantly, the SPPB has been successful in predicting the development of disability among those individuals who had no disability at the time of administering the test1. When administered within the first 24 hours of admission to a hospital, the SPPB was also found to accurately predict the patient’s length of stay in the hospital, as well as re-hospitalization and mortality over the year after hospital discharge. 3 In addition, the SPPB was able to detect early stages of frailty among high functioning older adults with normal walking speeds.4 The SPPB also has the potential to be used as early predictor of declining pulmonary function in clinical settings and epidemiological studies.5
OUTCOME MEASURES [Total Score]
0–4 = Greater risk of re-hospitalization or death (odds ratio: 5.38, 95% confidence interval: 1.82–15.9) 1
< 6 = Fall risk (w/ 7- 9 likelihood of recurrent falls) 6
8 = Frailty in elderly w/ good function (52% sensitivity & 70% specificity) 2
REFERENCES 1) Guralnik, Jack M., et al. "Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability." New England Journal of Medicine 332.9 (1995): 556-562. 2) Studenski, Stephanie, et al. "Physical performance measures in the clinical setting." Journal of the American Geriatrics Society 51.3 (2003): 314-322. 3) Volpato, Stefano, et al. "Predictive value of the Short Physical Performance Battery following hospitalization in older patients." The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 66.1 (2011): 89-96. 4) Verghese, Joe, and Xiaonan Xue. "Identifying frailty in high functioning older adults with normal mobility." Age and ageing 39.3 (2010): 382-385. 5) Choi, Ho-Chun, et al. "An implication of the short physical performance battery (SPPB) as a predictor of abnormal pulmonary function in aging people." Archives of gerontology and geriatrics 54.3 (2012): 448-452. 6) Veronese, Nicola, et al. "Association between short physical performance battery and falls in older people: the progetto veneto anziani study."Rejuvenation research 17.3 (2014): 276-284. 7) da Câmara, Saionara Maria Aires, et al. "Using the Short Physical Performance Battery to screen for frailty in young‐old adults with distinct socioeconomic conditions." Geriatrics & gerontology international 13.2 (2013): 421-428. 8) Vasunilashorn, Sarinnapha, et al. "Use of the Short Physical Performance Battery Score to predict loss of ability to walk 400 meters: analysis from the InCHIANTI study." The Journals of Gerontology 9) Puthoff, Michael L. "Research Corner Outcome Measures in Cardiopulmonary Physical Therapy: Short Physical Performance Battery."Cardiopulmonary physical therapy journal 19.1 (2004): 17-22.
The SPPB is a set of objective measures of lower extremity physical performance consisting of standing balance, chair stands, and gait speed. The assessment showing a gradient of risk for mortality, nursing home admission, disability and can be used as an indicator of frailty. The SPPB takes only a few minutes to complete, requires little training, simple equipment, results can be quantified by scores, and it is reproducible and sensitive to functional changes over time.
LEARNING OBJECTIVES:
1) Learn more about the SPPB
2) Learn how to score the SPPB
3) Learn who is appropriate for the SPPB
4) Learn the SPPB outcome measures
SPPB TESTING PROCEDURES1
The SPPB includes three objective tests of lower body function: 5 timed, repetitive chair stands a hierarchy standing balance test, and a timed 8-foot walk. According to specific cut-points a score of 1-4 represents the hierarchical performance for each test.1
- Chair Stands: This tests the participant’s ability to rise form a regular height, straight-back chair. The participant will try and stand up five times repeatedly as quickly as possible with arms folded across the chest. The tester allows for a demonstration to establish proper body mechanics and assess performance before testing.
- o 0 = unable; 1 = > 16.7 sec
- o 2 = 16.6-13.7 sec
- o 3 = 13.6-11.2 sec
- o 4 = < 11.1 sec
- Standing Balance: The participant is first asked to place their feet in side-by-side position, followed by a semi-tandem position, and tandem position. In order to advance from the first position to the next, the previous stance must be held for 10 seconds.
- o 0 = side by side 0-9 sec or unable
- o 1= side by side 10 sec, < 10 sec semi-tandem
- o 2= semi-tandem 10 sec, tandem 0-2 sec
- o 3= semi-tandem 10 sec, tandem 3-9 sec
- o 4= tandem 10 sec
- 8-foot walk: The participant is asked to walk at their normal pace from a standing position a distance of 8 feet (2.4 meters) and is allowed to use an assistive device if normally needed. Timing begins one the word “go” from the tester and ends once the established distance is crossed.
- o 0 = could not do
- o 1 = >5.7 sec (<1.40 ft/sec)
- o 2 = 4.1-6.5 sec (1.44- 1.97 ft/sec)
- o 3 = 3.2-4.0 sec (2.00-2.50 ft/sec)
- o 4 = <3.1 (>2.56 ft/sec)
By summing the 3 individual test items, a summary score is created. There is a potential range of 0-12, with higher scores indicating better lower body function.TESTING POPULATIONS
SPPB was very predictive of risk of disability among the community-dwelling patients 2. In addition, use of the test has predicted patient mortality, the need for admission to a nursing home and reliance on health care among the general older population, as well as continued decline in ADLs. Most importantly, the SPPB has been successful in predicting the development of disability among those individuals who had no disability at the time of administering the test1. When administered within the first 24 hours of admission to a hospital, the SPPB was also found to accurately predict the patient’s length of stay in the hospital, as well as re-hospitalization and mortality over the year after hospital discharge. 3 In addition, the SPPB was able to detect early stages of frailty among high functioning older adults with normal walking speeds.4 The SPPB also has the potential to be used as early predictor of declining pulmonary function in clinical settings and epidemiological studies.5
OUTCOME MEASURES
[Total Score]
FURTHRER OUTCOME MEASURES in cardiopulmonary PT 9
[Total Score]
- 0-3 = Severe limitations
- 4-6 = Moderate limitations
- 7-9 = Mild limitations
- 10-12 = Minimal limitations
[MCID 1,9]ADDITIONAL RESOURCES: Attached PDF 1-4
1 https://research.ndorms.ox.ac.uk/prove/documents/assessors/outcomeMeasures/SPPB_Protocol.pdf
2 http://www.brandeis.edu/roybal/docs/SPPB_website.pdf
3 http://www.asph.sc.edu/dpt/dpt-rehab/pdf/registry_of_outcome_measures_with_mdc_2010.pdf
4 http://geriatrictoolkit.missouri.edu/SPPB-Score-Tool.pdf
5https://books.google.com/books?id=ZbMKAQAAQBAJ&pg=PA475&lpg=PA475&dq=SPPB+outcome+measure&source=bl&ots=kqhtRZeG80&sig=HhwsMKeR-YTpdXqaxxbl3pXfKqE&hl=en&sa=X&ved=0ahUKEwi0gNS3_ZPNAhWGPT4KHe9pDTQ4ChDoAQgnMAI#v=onepage&q=SPPB%20outcome%20measure&f=false
REFERENCES
1) Guralnik, Jack M., et al. "Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability." New England Journal of Medicine 332.9 (1995): 556-562.
2) Studenski, Stephanie, et al. "Physical performance measures in the clinical setting." Journal of the American Geriatrics Society 51.3 (2003): 314-322.
3) Volpato, Stefano, et al. "Predictive value of the Short Physical Performance Battery following hospitalization in older patients." The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 66.1 (2011): 89-96.
4) Verghese, Joe, and Xiaonan Xue. "Identifying frailty in high functioning older adults with normal mobility." Age and ageing 39.3 (2010): 382-385.
5) Choi, Ho-Chun, et al. "An implication of the short physical performance battery (SPPB) as a predictor of abnormal pulmonary function in aging people." Archives of gerontology and geriatrics 54.3 (2012): 448-452.
6) Veronese, Nicola, et al. "Association between short physical performance battery and falls in older people: the progetto veneto anziani study."Rejuvenation research 17.3 (2014): 276-284.
7) da Câmara, Saionara Maria Aires, et al. "Using the Short Physical Performance Battery to screen for frailty in young‐old adults with distinct socioeconomic conditions." Geriatrics & gerontology international 13.2 (2013): 421-428.
8) Vasunilashorn, Sarinnapha, et al. "Use of the Short Physical Performance Battery Score to predict loss of ability to walk 400 meters: analysis from the InCHIANTI study." The Journals of Gerontology
9) Puthoff, Michael L. "Research Corner Outcome Measures in Cardiopulmonary Physical Therapy: Short Physical Performance Battery."Cardiopulmonary physical therapy journal 19.1 (2004): 17-22.